Family / Friend Referral

Where the person is an adult, please also ensure you have consent from the individual before making the referral.

Please be mindful if the individual and/or family are open to another therapeutic intervention, then, unfortunately, they can not be referred to an external agency for therapy.

The Headlight Project provides Counselling and Therapeutic support to people bereaved by suicide in the Tees Valley area. A member of our team will be in touch within 7 days from your date of referral.

Please note – The Headlight Project is not a general well-being, grief counselling or crisis service and we are unable to accept any referrals for individuals open to Secondary Care Mental Health services. If you need immediate crisis support, please click here for further help and support.

Referrer name

Referrer’s relationship to the individual

Referrer’s telephone number

Referrer’s email address

Client Type

Adult

Child

Client first name

Client surname

Client DOB

Parent's name

Client contact number

Parent’s contact number

Client Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Consent

I consent to being contacted by RDHP

Reason for referral

Other agencies involved

names and contact details

Consent

I have read and understood the privacy notice.

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